Tag Archives: leadership

The Prevailing Organizational Culture

Recruiting new employees involves being mindful to the predominant organizational culture and how the applicant will relate and interact with the current employees (Cable & Judge, 1997; Fallon & McConnell, 2007). For instance, in a highly team-structured, or cooperative, environment, a highly competitive applicant may find difficulty in overall acceptance by the team, and both the applicant’s job performance and that of the team may suffer (Chatman, 1989). However, when the organizational values match that of the applicant’s, then a prediction can be made that job satisfaction and organizational commitment will be higher (Cable & Judge, 1997; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999).

This paper will discuss organizational culture and the benefits and drawbacks of recruiting processes focused on maintaining or altering the status quo.

Recruiting Organizational Culture

The term organizational culture has been used since the early 1980’s to capture the perceptions, values, behavioral norms, and expectations inherent in an organization (Vandenberghe, 1999). This culture could be a result of certain pressure from the leadership or a natural environmental attainment; however, hiring practices certainly have an impact on the organizational culture by adding the influences of new personalities into the culture (Cable & Judge, 1997; Chatman, 1989; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999). Recruiters and managers, by hiring based on organizational fit, are able to exert influence over the direction of the organizational culture as well as help to limit turnover and attrition (Cable & Judge, 1997; Chatman, 1989; Christensen & Wright, 2011; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999).

One problem surrounding the use of organizational fit is the propensity of applicants to utilize influence tactics to alter the perceptions of the interviewer (Higgins & Judge, 2004). As Fallon and McConnell (2007) discuss, an inexperienced interviewer could be overly influenced by an applicant. “No one has yet devised a reliable way to separate the applicants who simply talk a good job from those who will later do a good job” (Fallon & McConnell, 2007, p. 179). A very charismatic applicant might benefit over a more qualified applicant.

The benefits, however, of considering organizational fit and value congruency between applicants and the organization are best appreciated after job fit, or the consideration of qualifications and experience, is determined. In a hiring process where applicant qualifications and experiences have already been vetted and references already checked, organizational fit can be used to further the success of both the organization and the applicant (Christensen & Wright, 2011; Tsai, Chi, & Huang, 2011).

Another benefit considering organizational fit is public service motivation. Christensen and Wright (2011) explore the relationship between applicants who have strong motivations towards public service and organizations, whether public or private, that share that motivation. Christensen and Wright show a result of increased job satisfaction when public service motivations are congruent between applicant and organization; however, this link appears fairly weak when compared to financial incentives.

Relying on Résumés and Portfolios

While most assessments of organizational fit are made in the interview environment, résumé contents offer useful information. Although Higgins and Judge (2004) regarded self-promotion tactics (résumés and portfolios) as “weak and nonsignificant” (p. 630), ergo, less powerful than personal influence tactics, Tsai, Chi, and Huang (2011) later show that specific pertinent résumé content improved perceptions of employability: “to select applicants with suitable attributes, recruiters would refer to specific résumé content as the basis for making inferences about applicants’ values or personality” (p. 236). Work experience and extracurricular activities, according to Tsai, Chi, and Huang, provide the most insight into an applicant’s values and personality, which would influence organizational fit.

One drawback to relying on a document, such as a résumé or a portfolio, to provide insight into an applicant’s values or personality is that often these documents are prepared by a third party whose personality and values might influence the choice of content, thereby influencing the reader.

Legal and Regulatory Implications

Fallon and McConnell (2007) readily discuss the legal requirements and implications of the hiring process and making judgments of the applicant that are not directly related to the job; however, if intangible traits can be related to improved job performance, it is recommended to probe for these after ensuring adequate qualification and experience. In order to show that these intangible traits (e.g. innovation, team orientation, stability, attention to detail) are relevant, the job description could be altered in effect to demonstrate this and limit legal implications of a subjective hiring process. Certain prohibitions will still stand, such as disability, race, color, creed, religion, et al.

Discussion

By understanding the culture of their organization, managers and recruiters can, to a degree, help to shift the cultural paradigm by choosing applicants who share similar values and beliefs that would be believed to enhance the culture of the organization. Although each job requires an applicant with the requisite knowledge, skills, and abilities to perform the job, certain intangibles, including congruence with the prevailing organizational culture, will help to ensure a healthy and lasting employment relationship.

Social media has blossomed in the past few years beyond what many could have imagined. Today, it seems that many people engage others on the internet and social media without regard to their own personal privacy. Additionally, according to Jones and Behling (2010), privacy settings within social media applications tend to be complex, which inhibits their effective use by privacy-minded users. The result is an open and rich source of personal data, the problem of which is context.

I view social media as personal advertising where, unless specifically stated in the terms of service, the information posted by others is considered to have entered the public domain; others may view social media in the light of property rights where, although many people might not lock their front door, the invitation to invade the space is not assumed (Rosen, 2009). Regardless of personal views, information seekers need to be mindful of three things: 1) the terms of service for using the application resources, 2) the privacy policy in effect for using the application resources, and 3) the context of entries and the audience each entry is meant to reach (Jones & Behling, 2010; Rosen, 2009). Considering that the personal data made available on social media applications is not typical of allowable employment interview scenarios, employers need to be mindful that searching out this information may lead to unethical and illegal hiring practices (Fallon & McConnell, 2007; Jones & Behling, 2010; Rosen, 2009). Still, employers use social media to further vet applicants (Jones & Behling, 2010). Another consideration along similar lines is the use of generic web-based searches that could uncover similar information (Rosen, 2009).

In the case study provided by Coutu (2007), Virginia performed an internet search on Mimi and know suffers the problem that one cannot unknow knowledge. Additionally, Virginia know feels ethically compelled to share this information with Fred, the CEO. While this information would not be pertinent in the hiring process of a line employee, staff employees require more scrutiny, especially those that are being vetted for significant leadership positions. Rosen (2009) states, “employers do have broader discretion if such behavior would damage a company, hurt business interests, or be inconsistent with business needs” (para. 15). With this in mind, I tend to consider the paradigm of privacy practices when confronted with public officials and celebrities. A public head of a company or division might not have the same expectations of privacy afforded to a typical job applicant, but this would be a question for lawyers, as Mimi alludes to in the case study.

Basing the decision to investigate Mimi via Google on the general welfare of the organization, I would recommend allowing Mimi to defend her position in order to minimize bias and assumption. Two questions could be asked of Mimi that may allow her to mitigate concerns stemming from the search: 1) Regardless of any past pretenses, do you feel that you can represent this company appropriately if faced with issues regarding international politics? 2) Do you have any concerns about operating effectively within a political environment, such as China? Asking these questions, however, assume that the legal ramifications have been assessed and that they have been deemed appropriate for these particular circumstances. Ultimately, however, the decision lies with Fred to formulate a team that he feels can further the goals of the organization. He may consider the search results inconsequential and hire Mimi regardless of these findings, which would also be appropriate.

Rosen, L. (2009, September 15). Caution! – Using search engines, MySpace or Facebook for hiring decisions may be hazardous to your business. Retrieved from http://www.esrcheck.com/articles/Caution-Using-Search-Engines-MySpace-or-Facebook-for-Hiring-Decisions-May-Be-Hazardous-to-Your-Business.php

Every organization is formed with a purpose in mind, the vision. In order to achieve this purpose, positions within the organization must work toward attaining certain goals furthering the larger organizational vision, the mission. Those who administer these organizations must catalog and organize the requisite roles, tasks, duties, and responsibilities required to achieve the goals and vision of the organization. This process is called job analysis and results in position descriptions for each job required to facilitate the mission of the organization (Fallon & McConnell, 2007). Position descriptions serve as a framework to codify the chain of command, roles and responsibilities, and functional lists of duties to be performed (Fallon & McConnell, 2007). Position descriptions also help to determine the value and compensation requirements of each position (Fallon & McConnell, 2007).

Unfortunately, as Fallon and McConnell (2007) discuss, many organizations fail to create adequate position descriptions, putting the organizations at risk of possible litigation, or less severe, employee confusion and ultimate inefficient operations.

Taxonomy of a Position Description

Fallon and McConnell (2007) write adamantly that “job descriptions have a regular format, style, and language” (p. 119) and are a result of a vigorous job analyses. Fallon and McConnell outline the components of a valid position description: job title, FLSA status, a summary of duties, compensation (salary range), knowledge required to perform the job, particular skills required to perform the job, the level of physical, psychological, and emotional effort usually required to perform the job, responsibilities inherent in the position, typical working conditions, and other general statements describing the position. Position descriptions using this format and with a certain level of detail can also be helpful in evaluating employees already in the position.

Using this format, I will compare two similar health care position descriptions (Northwest EMS, 2007; U. S. Office of Personnel Management, 2012) and discuss their similarities and differences.

Comparing and Contrasting Position Descriptions

Northwest EMS: Paramedic

Northwest EMS, located in Tomball, Texas, is the municipal provider of emergency medical services. Either city or departmental human resources would have directed the analysis required to formulate the position description.

Strengths. This paramedic position description (Northwest EMS, 2007) clearly follows a similar outline as recommended by Fallon and McConnell (2007). Further, as this position requires particular licenses, certifications, and other qualifications, these are enumerated distinctly as minimum qualifications for the position.

The biggest strength of this position description, however, is the section which details very particular job requirements, both physical and non-physical, as they relate to the Americans with Disabilities Act.

Weaknesses. This position description does not provide a salary range for the position. Although this could be a result of the document lying in the public domain and quickly becoming outdated, a salary range should be communicated openly for applicants to consider. This would benefit both the organization and the applicant, ensuring recruitment resources are expended only on applicants with a continued interest in the position.

National Park Service: Paramedic

This position is within the National Park Service at Yellowstone National Park. The position description would have been developed through position analysis by the U. S. Office of Personnel Management at the direction of the National Park Service.

Strengths. This paramedic position (U. S. Office of Personnel Management, 2012) also follows a similar outline as recommended by Fallon and McConnell (2007) and also provides that certain licenses, certifications, and other qualifications are required; however, as this is a federal position governed by separate and particular rules, there are particular components within the position description that are unique to federal government job postings.

One strength of this position description that notably differs with the Northwest EMS description is the inclusion of the salary range.

Weaknesses. No FLSA status is noted within the position description, but the FLSA might not apply to this federal position.

Discussion

In analyzing similar position descriptions within municipal and federal organizations, there will be particular differences guided by the requisite employment rules and legislation for each; however, there are certain universal requirements for adequately describing the duties and responsibilities of each position, and it seems that both the Northwest EMS (2007) and National Park Service (U. S. Office of Personnel Management, 2012) position descriptions are, indeed, adequate representations of each paramedic job.

“Didn’t Cut It? Hire Another”

Human resource management (HRM), especially when considering employment contracts, is heavily reliant on the understanding of the laws and regulations governing the jurisdiction of practice, whether these laws and regulations are local, state, or federally mandated. Fallon and McConnell (2007) demonstrate that “many laws and other legal requirements exert considerable influence on the employment process …. [and,] managers must [also] be aware of many aspects and nuances of HR law….” (p. 127). Kathy Gray’s difficulty, as described in the Fallon and McConnell chapter seven case study, arises from a culture within the organization that does not appear to respect the utility of HRM as both necessary and effective for the business. In the scenario, Kathy Gray is tasked with hiring a clerk for an open position; however, as soon as she makes her determination of the candidates, Sam Weston undermines the authority bestowed upon her and hires the lesser qualified of the two applicants. This would be difficult for anyone in a similar situation.

There are a number of problems that could stem from this scenario. First, by hiring the less qualified candidate, the business will utilize resources in training the chosen candidate only to seek out a replacement before recouping the expenses related to hiring and training the individual. O’Brien (2010) describes “the process of recruiting, selecting, hiring, and retaining employees [to be] difficult and costly” (p. 113). It would seem obvious that the chosen candidate should be the most qualified to save both cost and effort. Second, by Sam Weston undermining Kathy Gray’s authority, he has made her less effective as a leader. Kathy Gray was hired as a business manager and must earn the respect of those within the organization that she leads. By undermining her hiring authority, Sam Weston creates the perception that she is not prepared in her role as a manager. Fallon and McConnell (2007) posit that Sam Weston should have merely prepared himself to be a resource for Kathy Gray had she met difficulty in carrying out her newfound responsibilities. I have to agree as this would have allowed Kathy Gray to develop confidence in her new role, and a clear message would be sent throughout the organization regarding Kathy Gray’s authority in matters pertaining to her office. Although Sam Weston did choose an inept candidate, I do not see any reason why Kathy Gray cannot terminate the employment of her subordinate herself, as is the organizational norm. That being stated, there are better methods of dealing with employment matters than ad hoc hiring and firing of personnel by managers (Fallon & McConnell, 2007; O’Brien, 2010).

Fallon and McConnell (2007) and O’Brien (2010) both agree that HRM is a systematic approach to employment matters with ethical and legal considerations and implications. Meadows Nursing Home, the organization discussed in Fallon and McConnell’s case study, would do well to employ a human resources specialist (if not a human resources department) to handle the vetting of applicants, from within the organization as well as without. By developing a working partnership with the human resource team, managers can be assured that chosen applicants have met the minimum requirements for job performance, that job descriptions are accurate and detailed, and that, in the event an employee must be separated from employment, it will be handled in a professional, legal, and proper manner.

Finally, consideration should always be given to applicants within the organization before looking outward to fill vacancies. Employing from within demonstrates to the current staff a culture and willingness to cultivate talent and allow professional growth as a reward for loyalty. Also, current staff are already familiar with the business processes that an outsider may find atypical, and this would lead to short assimilation time; however, the organization runs the risk of “organizational in-breeding” if not enough outside influence is achieved (Eisenberg & Wells, 2000). With this in mind, promotions from within should be the norm unless considering vacant management positions, which should be advertised both within and outside of the organization in order to ensure competition among the candidates.

Mrs. Jackson’s Dilemma

In the dilemma of Mrs. Clara Jackson, as presented by Fallon and McConnell (2007), the emergence of health care professions created a vacuum of administrative roles that, until this time, were haphazardly fulfilled by senior clinical staff. Mrs. Jackson, professionally torn between clinical and adminstrative roles, understood that one would suffer for the attention spent on the other. As this realization set in, Mrs. Jackson allowed non-clinical supervisors to hire employees; however, this tended to decentralize the function of personnel management. This ad hoc methodology would eventually prove detrimental as regulations and legal requirements become standard. Mrs. Jackson could enlist an assistant to help with these administartive roles, but an unprepared assistant would prove as detrimental as the decentralized process previously discussed.

These issues, requiring a sense of increasing specialization and knowledge, helped to form the field of human resource management (HRM) as we understand it today. HRM strives to use a form of “ethical stewardship[,] … a philosophy of leadership and governance that optimizes long-term wealth creation and that honors duties owed to all stakeholders” (Caldwell, Troung, Linh, & Tuan, 2011, 178), to “help their organizations add value to the lives of individuals and organizations” (Caldwell, Troung, Linh, & Tuan, 2011, p. 177). This philosophy helps to gain “commitment from employees which is the key to long-term wealth creation” (Caldwell, Troung, Linh, & Tuan, 2011, 178). Using this philosophy of ethical stewardship, HRM managers would have enlisted the help of Mrs. Jackson to formulate a list of requisite knowledge, skills, and abilities (KSAs) needed to perform each clinical job and hire nurses based on these, while meeting the requirements of employment law and regulation, so as to free Mrs. Jackson to perform her senior clinical role unimpeded.

As a paramedic, I become discouraged when so-called academic literature, like that of McLean, Maio, Spaite, and Garrison (2002), Spaite (1993), and Stiell et al. (2008), turns up describing what little impact the emergency medical services, especially advanced life support procedures, have on patients. Instead of dismissing these writings, I tend to focus within the view of my own practice and experience on how I feel that I impact the patients that I see. This exercise allows me to confront the literature in a specific and meaningful manner that might be used in the future to publish a dissenting view. This discussion gives me a lens through which to dissect the import I feel that the emergency medical services has as a public safety entity.

Public safety is typically viewed as the amalgamation of police, fire, and emergency medical services. In all three, the public seems to have the idea that we stop threats before they take hold; however, we typically respond to the aftermath, the police to investigate crimes that have already occurred, the fire department to conflagrations that have already caused damage, and emergency medical services to traumatic incidents or medical conditions that have already caused distress. There are exceptions. The police have learned to integrate crime prevention techniques, the fire department has learned to adopt a fire prevention model of service, and the emergency medical services in many areas support preventative health clinics, such as community immunization, blood pressure checks, and CPR and first aid classes. The public, I feel, has a skewed perception of each one of these departments (e.g. the police should stop crime in progress, the fire department should save their house, and emergency medical systems should save their loved one whenever called upon to do so). Any deviation from the public perception is, in their minds, a failure of the system.

I ask myself, “What is that we, as the emergency medical services, do that really matters?” For the public, it seems that the answer can be given two-fold: “save me” and “make me feel better.” El Sayed (2012) describes the manner in which both aspects, outcomes and patient satisfaction, can be measured, as both are essential. Unfortunately, El Sayed does not go into much detail regarding patient satisfaction scores, except as a means of measure. In contrast, I feel that the most benefit that we offer patients is that we alleviate suffering. From a confident, yet compassionate, bed-side manner to effective and efficient treatment modalities, emergency medical personnel can prove to be the mediator between illness or injury and definitive hospital-based care. Emergency medical providers should be knowledgeable enough about the hospital to calm and educate patients as to what to expect. Further, medical knowledge allows the provider to restore a choking person’s breathing, to stop an epileptic seizure, and to minimize a crash victim’s pain. In my opinion, these measures are just as important, if not more, to quality management as mortality and morbidity. Again, El Sayed mentions the generality of patient satisfaction; however, with the abundance of competing literature questioning the effectiveness of the emergency medical services, patient satisfaction should be expounded upon as a legitimate and important aspect of quality patient care.

Seattle Children’s Hospital (2011, n.d.) was the first pediatric specialty care hospital founded west of the Mississippi River. Seattle Children’s Hospital, supported by the philanthropic efforts of the community, performs at the cutting-edge of pediatric medicine and research. With nearly 60 pediatric specialties and award-winning research faculty, Seattle Children’s Hospital presents expertise in the field of pediatric medicine.

Services

Seattle Children’s Hospital (n.d.) is a pediatric specialty care center associated with the University of Washington to provide medical and surgical residents with the hands-on practical experience and education needed to succeed in the medical profession.

The hospital (Seattle Children’s Hospital, n.d.) has many specialized programs, or sub-specialties, within its pediatric specialty, including urgent and emergency care, oncology and hematology, craniofacial, orthopedic and sports medicine, a heart and transplant center, neonatology, neurosurgery, and general and thoracic surgery.

Strategic Planning

The strategic plan of Seattle Children’s Hospital (2011) focuses on the hospital’s vision and four specific goals:

provide the safest, most effective care possible,

control and reduce the cost of providing care,

find cures and educate clinicians and researchers, and

grow responsibly and provide access to every child who needs us (p. 2).

In order to succeed in reaching these goals, the hospital’s plan must have directives that outline the strategies and tactics useful in attaining the goals.

Strategy

Strategy is the broad means directed towards attaining strategic goals. As Seattle Children’s Hospital’s (2011) strategic plan demonstrates, in order to achieve the means of providing the safest, most effective care possible, “[the hospital] will standardize our care processes and strengthen our systems to prevent and respond rapidly to medical errors” (p. 5). This strategy is broadly stated, provides direction, and acknowledges that failures may still occur, which allows for the provision of a secondary, or backup, strategy for response to these failures.

Tactics

Tactics are the individual steps made within a strategy towards attaining a specific goal. Tactics should be moral, safe, efficient and effective towards the strategic goals. For instance, the strategy of “[standardizing] our care processes and [strengthening] our systems to prevent and respond rapidly to medical errors” (Seattle Children’s Hospital, 2011, p. 5) is well-stated, yet broad. In order to employ this strategy, tactics must be employed that are specific to meeting the described goal. In this case, Seattle Children’s Hospital (2011) has identified that “[completing] the transition to an electronic medical record system” (p. 5) is a specific means that can be used to help fulfill this particular strategy and meet the described goal.

Another tactic not presented in Seattle Children’s Hospital’s (2011) strategic plan but helpful in attaining the goal of improved patient safety and drawn from the strategy of “[standardizing] … care processes and [strengthening] … systems” (p. 5) would be the formation of an anonymous, voluntary self-reporting system in which a nurse or physician submits a card detailing a medical or surgical error in the spirit of identifying processes and systems in need of improvement.

Discussion

Strategic plans are guided by strategic goals, and strategic goals can have many strategies that are employed and useful in meeting the stated goals. It is also true that a plethora of tactics can be employed for each strategy.

Strategic plans are often based on lofty, yet attainable, goals. In order to meet these goals, one must only ask a simple question: How? With each broad answer, a continuous and recursive series of How? can be used to work the strategy into a number of manageable tactics to use to reach that lofty goal.

Day Kimball Healthcare (DKH) is a non-profit health care organization serving the northeastern Connecticut, southcentral Massachusetts and northwestern Rhode Island communities. The mission of DKH (2011) is “to meet the health needs of our community through our core values of clinical quality, customer service, fiscal responsibility and local control” (para. 4). A comprehensive health care system, DKH offers primary care and a multitude of medical and surgical specialties along with sophisticated diagnostics by offering a comprehensive network of more than 1,000 employees including more than 200 physicians, surgeons and specialists. DKH is comprised of Day Kimball Hospital, four community health care centers, Day Kimball HomeCare, Day Kimball Hospice & Palliative Care of Northeastern Connecticut, Day Kimball HomeMakers, and Physician Services of Northeast CT, LLC.

Services

DKH provides a host of services to the community, including:

primary medical care,

emergency medical care,

surgical care,

palliative and hospice care,

home health care, and

social services

DKH appears to strive towards providing a comprehensive health care solution to the community that is robust, yet limited in specialty, especially critical care, trauma, and pediatric services.

Environment

Population

The primary catchment area for DKH includes the Connecticut towns of Brooklyn, Canterbury, Eastford, Killingly, Plainfield, Pomfret, Putnam, Sterling, Thompson, and Woodstock, and the Rhode Island towns of Foster and Glocester. According to the available U.S. Census data (2010), the population served is nearly 92,000 with average growth in the last ten years of nearly 9%. The median age of the catchment population (37.8) is merely 3 months older than the median age of the Connecticut population (37.4). The median household income is $66,422 (CT: $67,034).

Competition

DKH is the primary health care provider within the defined catchment area. Some of the population, however, rely on three other community-level hospitals, Backus Hospital (Norwich, CT), Southbridge Hospital (Southbridge, MA), and Windham Hospital (Windham, CT). Additionally, some of the population with advanced disease processes rely strictly on the primary and emergency care services of the nearest urban centers (Worcester, MA, Hartford, CT, and Providence, RI), with many of DKH’s emergency patients transferred to these tertiary care centers for trauma, critical care, and pediatric specialties.

Environment

DKH, as a health care organization, can be adversely affected by patterns of infectious diseases within the community. As each season mounts, the health care system becomes overwhelmed and requires coordination between other health care facilities in the area.

Additionally, a large disaster would strain the resources of DKH; however, this would be a temporary issue, resolving as the disaster winds down. There is ample opportunity within the catchment area for a disaster to unfold, including traffic on the major highway that divides the catchment area as well as the number of large manufacturing entities in the area.

Assessment

Strengths. DKH provides comprehensive long-term health care to community members. DKH enjoys a strong and comprehensive relationship with a large network of physicians and other primary care providers.

Weaknesses. DKH has no intensivists, physicians with expertise in critical care, and provides very limited critical care service. As a result, DKH must transfer many cases to other facilities to rule in or rule out critical illnesses or injuries, which negatively affects earnings.

Another weakness lies in DKH’s reliance on electronic patient care reporting. DKH uses a number of patient care reporting platforms that do not integrate with each other. This creates a need for over-redundancy and opportunities for patient care errors. Further, a fully integrated system would allow for health care partners to access up-to-date patient care information without delay.

Opportunities. Opportunities exist for DKH to expand their services by further decentralizing the current services offered and concentrating on which scopes of service to expand or improve upon. By improving laboratory reporting standards and facilitating full integration of patient reporting, patients of DKH will be able to obtain a more standardized level of care throughout the health care continuum.

DKH should cultivate their relationship with the public by being more active and visible within the community performing screenings, vaccinations, blood drives, as well as other public relations endeavors.

Another opportunity exists with the patient population who suffer from critical illness or injury that is yet to be determined. These patients face risk in transport to tertiary care centers when, often times, the transfer is unwarranted by later findings. By cultivating relationships with specialties in the tertiary care centers, these patients could be more fully determined to need (or, not need) transfer to tertiary care centers, keeping the financial reward of caring for patients in-house while obtaining specialist coordination.

Threats. The largest threat to DKH, as with any organization, is its reputation within the community. Funding, which is largely based on governmental and private insurance providers, is also a considerable threat that must be managed continuously. However, other threats are significant and can be actively managed.

Pandemics are unlikely to occur but present catastrophic scenarios if they do, indeed, occur. Pandemic influenza, as well as other pandemic diseases, presents a situation of an increasing need for awareness and preparation.

Unpredictable weather in the northeastern Connecticut presents a likely and significant threat to the provision of health care. Recent and historical storms have proven to impede access and egress to and from patients both out in the community and at the hospital.

Discussion

This SWOT analysis is limited by the a posteriori knowledge and perceptions of the author, a paramedic who is active within the health care system, and it is limited in the scope of an academic exercise to practice SWOT analyses.

However, DKH has overcome many adversities in the past and continues to grow, but seemingly without proper direction. The efforts thus far seem disjointed and without a clear structure or coherent path into the future. DKH would benefit from an internal SWOT analysis that could be performed without the limitations inherent herein.

References

Day Kimball Healthcare. (2011). Day Kimball Healthcare. Retrieved from http://www.daykimball.org

Health care is a service devoted, by definition, to those who are vulnerable. People seek out health-related services during stressful times and may be easily swayed into trying less than effective methods, even ‘snake oil’ remedies, for treating their ails and pain. This being the case, the health care provider has a moral obligation to advocate for the patient. Advocacy entails considering only what is in the best interest of others, even to the detriment of one’s self. Patient advocacy helps to ensure both health care quality and safety. The Institute of Medicine defines health care as “[the] degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge” (as cited in Savage & Williams, 2012, p. 26). Savage and Williams (2012) discuss the importance of effective and efficient delivery of health care, which means avoiding overuse (providing services to those who will least benefit) and underuse (failing to provide services to those that would benefit) stating, “quality is important in health care because there are limited resources to improve the health of both individuals and the population as a whole” (p. 72).

According to Savage and Williams (2012), all stakeholders are affected by the level of quality in health care. From a patient’s perspective, health care delivery should be aimed at addressing the patient’s problem with the least invasive, yet most effective, therapy possible. Delivering health care is a high-risk endeavor that focuses the risk towards the patient, potentially causing harm and great suffering. The provider, driven by the desire to help without harming, would benefit greatly by the development of ‘best practices’, or evidence-based practice, in order to help the most people with the available resources. Additionally, providers wish to be paid a fair rate in exchange for the services performed, and this can only occur in an efficient system with little waste to impact revenue. On the other hand, third-party payors, the most prolific purchasers of health care, demand the most effective and efficient services in return for their payment in order to control the costs of their own services. Third-party payors, like Medicare, Blue Cross, and others, have such a large client base that they are able to effectively negotiate health care services for lower rates.

As a health care manager, it is increasingly important to ensure quality and safety in the delivery of health services. Medical malpractice litigation, according to Savage and Williams (2012), is costly to practitioners and organizations, even though it does little to deter poor quality. Rather than relying on the courts to make forceful recommendations, an effective manager can use tools already available to promote best practice within their organization. For instance, continuous quality improvement (CQI) programs promote systematic, data-driven process improvements focused by the customer’s perceptions. CQI can uncover interferring processes and can make modest to significant improvements that can indirectly improve other, linear processes, thereby, making greater improvements, overall.

The true value of leadership is empowerment, or the ability to promote those traits through the chain of command for subordinates to use to effectively make decisions that are in the spirit of the vision of the leader (Buchbinder, Shanks, & McConnell, 2012; Kirkpatrick & Locke, 1991; Wieck, Prydun, & Walsh, 2002). When leaders make decisions, the focus is not on the myopic view of the here and now but reflects the nature of ethics and vision promoting the endeavor (Kirkpatrick & Locke, 1991).

Buchbinder, Shanks, and McConnell (2012), discuss various strategies and attitudes employed to both lead and manage the health care workforce. Though each of the styles presented are effectively used in certain scenarios, many managers and ineffective leaders misuse these styles due to misplaced attitudes, trust, and motives. These styles are authoritarian, bureaucratic, participative, theory Z, laissez-faire, and situational. The authoritarian and bureaucratic styles are closely related as dictatorial and at risk for involving micromanagement; however, authoritarians tend to be motivated by their responsibilities, whereas bureaucrats tend to disregard their responsibilities. The participative and theory Z styles are more democratic and egalitarian describing the usefulness of a majority opinion or consensus before moving forward. Though these styles could result in indecision, they are best implemented when a leader has ultimate decision-making capabilities and relies on his or her subordinates for input. Laissez-faire leadership is typically characterized as the hands off approach. Laissez-faire leadership, when used correctly, relies on the specialized training or focused scope of the work of the subordinates and lends guidance only when necessary. Laissez-faire leadership, however, can provide refuge for a lazy manager. Situational leadership is the use of all or some of the styles described above depending on the specific circumstances of a given situation. For instance, providing guidance to a new employee might benefit from an authoritarian approach; however, deciding on the best approach to implementing a new process might benefit from a participative style of leadership.

In the emergency medical services, a move has been made over the last decade to separate from the authoritarian leadership of the fire service. In my opinion (due to the gross lack of research within both the fire and emergency medical services), the attitudes of the fire service leadership do not correspond well with the manner in which paramedics wish to be led. As paramedics are formally educated and expected to perform as skilled clinicians in the field, they tend to operate independently and view their supervisors more as a resource tool than as tactical or clinical decision-makers. Combination departments, or those that operate both fire and emergency medical services, would do well with developing situational leadership skills to guide both operations (Mujtaba & Sungkhawan, 2009). Though paramedics may utilize an authoritarian style of leadership during an emergency call (and, do well to follow such styles in these environments), during normal day-to-day operations, paramedics respond much better towards a laissez-faire, or indirect, style of leadership that allows for independent critical thinking (Buchbinder, Shanks, & McConnell, 2012; Freshman & Rubino, 2002). For example, during a call, I expect that when I direct my crew to perform a certain task that it is completed immediately; however, between calls when I might say that in a particular scenario a certain intervention is necessary, I expect some discussion to aid in the learning of my crews and to help develop and hone their critical thinking skills.

True leadership has its own rewards, primarily, empowering those who follow to synthesize the traits of their leaders and evolve into leaders, themselves. This, in addition to watching your own visions take root and flourish.